AIDS: Science at a Crossroads

Panos AIDS Briefing No. 3
June 1995

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AIDS: SCIENCE AT A CROSSROADS
The science of AIDS and its impact on the developing world
In 1995, AIDS research stands at a crossroads. Over the past 10 years, much of the research on AIDS
has centred on trying to find a cure or a vaccine, with very limited results. While more has been learnt
about AIDS in a short time than about almost any other disease, many of the basic questions about the
development of AIDS and the behaviour of HIV, the virus which leads to AIDS, remain unanswered.
And the few treatments available for people with AIDS are expensive and beyond the budgets of
developing countries- which account for nine-tenths of the worlds' cases of HIV.
This briefing looks at the main scientific issues the epidemic has raised so far and the challenges ahead.
It reviews the basic information about HIV and AIDS and the available treatments for the disease,
setting out what is known and what is still uncertain. And it analyses some of the controversies
surrounding HIV.
Since 1981, when AIDS was first identified, research has moved fast but not fast enough to satisfy
anyone. A scattering of antiviral drugs exist that slow down HIV's replication, but none can prevent
the eventual onset of AIDS or death. Vaccines are now on trial, but even the most optimistic scientists
suspect that these will at best offer only partial protection against infection. It is also unlikely a
successful vaccine will be available in the next 10 years. Meanwhile, people continue to become
infected at the rate of several thousand each day.
Some scientists now believe that it is now time to re-emphasise basic research, to try and answer some
of the enigmas posed by HIV. For instance, how does HIV attack the immune system, the body's first
line of defence against infection? Why do some people with HIV stay healthy for many years, while
others develop AIDS quickly and die? Until we hold the answers to these questions, it may prove
impossible to find an effective cure for the disease, or a successful vaccine.
For the short to medium term, the outlook is difficult. Few scientists believe it is realistic to expect to
find an outright cure for AIDS. But many hope it will become possible to devise therapies that will
dramatically slow down the disease process and buy many years of healthy life. Even that more modest
goal, however, is still a long way off. Moreover, even if new therapies and vaccines are designed, will
they be affordable and available for developing countries?
Beyond the biomedical problems, there are complex behavioural and social difficulties. Even though
there are technically simple means such as condoms to stop the virus from spreading, those means are
not available or acceptable to many. Poverty and cultural constraints continue to deprive people of
control over their own lives and the power to protect themselves. It is not enough, for example, to
advise people to use condoms when many women have no say in their partners' behaviour and when
childbearing defines a woman's identity and status.

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